Friday, April 17, 2009

Folie à Trois Health Care

I had just spend an hour with the patient and her husband who lived here in Chicago discussing her condition and treatment options. So it was a strange moment when the husband of my patient walked out to me and handed me the phone.

"Can you talk to him?" he asked.

"Who's that?" I asked.

"Dr. Frigamafratz. He's our (concierge) doctor in Baltimore."

"Baltimore? Uh, sure."

I held the phone to my ear.

"Dr. Fisher?", a woman's voice asked.


"Please hold one second while I get Dr. Frigamafratz on the phone," a lady with a very business-like demeanor said.

I heard static, popping, a voice come and go... then...

"Hello, Dr. Fisher?" (static, hissss, clicks, hisss) "I'm Dr. Frigamafratz. Can you tell me what's going on?"

I told him about the situation, about the fact that those skipped heart beats she had been experiencing and intermittent periods of lightheadedness were likely caused by brief bursts of right ventricular outflow tract tachycardia. About her workup. About her structurally normal heart. About her treatment options and the various options for treatment that I had recommended.

"Uh, yes..." ( "Well, I see," he said.

Then silence.

"Hello? Hello?" I called.

The pleasant young lady came back on the line. "Yes, Dr. Fisher, I'm here. I'm sorry we must have lost Dr. Frigamafratz. I'd be happy to tell him the situation."

Frustrated and pushed for time, I capitulated and summarized the situation again to the lady on the phone, then handed the phone back to the husband. He thanked me for talking with their concierge doctor and I went on to complete my consult note and forwarded it back to the local referring physician. A while later, I returned to the room to see if my patient and her husband had decided on their course of therapy.

They chose medicines over ablation, much to my surprise given our conversation, but I understood her reluctance and respected her decision.

Later that evening, the patient's internist here in Chicago called me. I learned that our mutual patient had spoken with her concierge doctor, Dr. Frigamafratz, while I was writing my note. The internist was livid. Dr. Frigamafratz had not communicated with the internist about his input to the patient's care. (Doctors reading this know this is basic profesional ethics). I learned that Dr. Frigamafratz was a retired Emergency Room doctor and started this concierge's business to cater to high-end, well-traveled clients. I learned that the pleasant people on the phone were not nurses, but secretaries. Finally, I learned that Dr. Frigamafratz had recommended a therapy to my patient, yet knew nothing about her most recent situation and conducted his entire assessment over the phone without setting eyes on her or examining her.

No wonder the internist was livid.

As we plotted the next steps for our patient's treatment, I reflected on the growing movement for online, mobile, and internet-based physician care and suspect that we can expect more of these "who's on first" experiences in the years to come.



Anonymous said...

Gee, it's almost as if concierge medicine is a marketing gimmick perpetrated by doctors who don't really want to work on patients who value convenience more than their health.

Anonymous said...

What conversation do you have with the patient/spouse about how they've chosen to approach this? It seems it all starts with them...